WHEN DOCTORS BECOME PATIENTS by Robert Klitzman (Oxford, March, 2008)
When Harcourt bought CHANGE OF HEART: The Bypass Experience, my book interviewing 1100 veterans of coronary bypass surgery, I was elated. Flush with my success, I tried to convince them to publish my next book of interviews with 100 doctors who were veterans of coronary bypass surgery.
“Nobody will be interested,” retorted the editor. But he was wrong.
Robert Klitzman’s important new book, WHEN DOCTORS BECOME PATIENTS, proved just how wrong one editor can be.
Klitzman interviewed 70 physicians, male and female, young and old—from 25 to 87, all victimized by a variety of chronic and acute diseases including lymphoma, breast cancer, skin cancer, Huntington’s disease, heart attacks, depression, bipolar distress, and an overly high incidence of HIV.
Whatever their illnesses were, disease was isolating. Even though their different illnesses mandated a variety of diagnoses, treatment, responses, and coping mechanisms, many sick doctors felt left on their doorsteps by calloused and unsympathetic colleagues. Since 34 percent of doctors in Klitzman’s study were HIV positive or suffered from frank AIDs, most opted for secrecy. But the four women physicians killed by metastatic cancer within a year after Klitzman finished his book also faced “peripheralization and discrimination.” One physician reporting that her colleagues “treated me as if I were dead.”
Even if these doctor-patients wanted to talk to their physicians, communicating with physicians was a tough ball game. Here, the doctor who is sick confronts the same barriers as the non-doctor who wants to communicate with his or her physician.
A Berlin Wall blocked the two sides of the bedside. Perhaps fearful of their own futures, healthy doctors acted threatened by their sick colleagues. Many healthy MDs expected the sick to continue toting work loads despite their diseases. Some sick physicians, denying the inroads of illness, carried their share of patient care for as long as possible. Others gave in, willingly or unwillingly, to patienthood’s unwelcome passivity. Checking up on their doctors along the way, some found better doctors to care for them, others were distressed by the MDs they found.
Like the rest of us hit by illness, these doctors hated being sick, hated the world of patienthood, hated being burdens, hated how disease had changed them in the eyes of other doctors. Hospital gowns, patronizing paternalism, humiliated them. Superspecialists ignored them. Colleagues turned their backs.
What did sickness teach these doctor-patients? Written on their flesh was the truth behind Kafka’s words: “To write prescriptions is easy. To come to an understanding with people is hard.”
Klitzman believes that doctors who have been sick can learn from the ways their own doctors treated them. As a result, they “assessed this treatment with more knowledge and higher standards of comparison than do other patients…In doing so they offered insights and epiphanies that could help both other patients and providers.”
Learning empathy from their own experiences, most of these doctor-patients became better doctors, gentler, more understanding after they had battled with illness. They learned to “put myself in my patients’ clothes, “ to ask themselves, “How would I react?”
For every doctor is a possible patient. No one is immune. The white coat is not a shield. It’s just a white coat, stained with the blood of others, with the striving, successes, and defeats of caring for others. Medical school, internship and residency, rarely teach physicians that patienthood lies waiting for each of them, ready to pounce when least expected.
The doctors in Klitzman’s book are special. They were willing to trust Klitzman with their stories, albeit occasionally glossed over with denial. Their illnesses taught them “that they, too, will one day be patients, that the boundary between physicians and patients is, in the end, nonexistent.”
Readers, patients, doctor themselves must wonder: Do doctors have to be sick to understand what it means to be a patient? Is sickness a mandatory course in every physician’s education. Klitzman asks, “Can empathy be taught?” It’s a good question.
Physicians are victimized by the same invasions of the flesh as those striking their patients. Some physicians sicken and die at an early age. Others live long but the infirmities of age, chronic disease, or acute illness beset them.
How do physicians, trained to help others, deal with their own physical illness? Do they continue to practice? Do age or disease limit their ability to care for sick patients? Do they or their colleagues recognize what is happening to them? Does anyone help them?
Klitzman’s study raises many questions. How do physicians deal with their medical problems? Does being a physician exacerbate their physical problems? Do colleagues help—or hinder? How do care-providers treat physician-patients? The same as other patients? Better? Worse? What do physicians learn from going through major surgery or critical illness? From living with a chronic disease? How do these experiences affect their dealings with patients? Are they better doctors? If so, why?
Looking back, how well—or poorly—do physician-patients believe they were diagnosed, treated, monitored, and mentored? How well or poorly did they treat themselves? Will their experiences help other physicians? Help patients? Help themselves?
The medical literature contains little about physicians trying to cope with physical disease, whether chronic or acute. Almost no studies examine the dilemmas of physicians who are care-“providers” of physician-patients. Few medical schools adequately address clinicians’ well-being. These educational lacunae waste our most precious medical resource. For students, residents, and senior physicians all need to learn about the special problems of doctors confronting acute or chronic diseases—or even the not-so-“golden years” inflicted by the aging process.
Physicians providing care to physician-patients need special guidance. They need to unlearn the myths about doctor-patients that might compromise their care.
Klitzman’s book opens the door to the particular problems of sick or aging physicians. Readers everywhere, non-doctors and doctors alike should take it to heart.